Livers from donation after circulatory death donors can be safely used for retransplantation

O.B. van Leeuwen, M. van Reeven, J.I. Erdmann, H.J. Metselaar, A.P. van den Berg, W.G. Polak, B. van Hoek, R.J. Porte

Friday 16 march 2018

11:10 - 11:20h at Willem Burger Zaal

Categories: Clinical, Session (parallel)

Parallel session: Parallel session 13: Clinical

Introduction

As a result of shortage of suitable donor organs, donation after circulatory death (DCD) livers are increasingly used for orthotopic liver transplantation (OLT). In 2016, 31% of liver transplants in the Netherlands were performed with DCD grafts. However, after DCD OLT biliary complications and early allograft dysfunction (EAD) are more frequently observed than after donation after brain death (DBD) OLT. The outcomes after retransplantation with a DCD liver are not known. In many countries, retransplantation is a contraindication for the use of DCD livers. Therefore, we aimed to assess the results of patients undergoing retransplantation using a DCD liver graft.

Methods

In this multicenter retrospective study, all DCD reOLTs in the Netherlands between 2003 and 2017 were included. For each DCD reOLT, two DBD reOLTs livers were selected as a matched control group. Matching was performed based on number of successive reOLT, BAR-score (which includes MELD-score, donor age, recipient age, use of life support prior to OLT and reOLT yes/no), early (<3months) or late(≥3months) reOLT and year of retransplantation, respectively. Baseline characteristics of both donor and recipient and outcomes parameters were collected and analysed. Early allograft dysfunction (EAD) was defined according to the Olthoff criteria, NAS as bile duct strictures within two years after OLT at any location in the biliary tree other than the anastomosis. Continuous data are shown as median (IQR).

Results

Nineteen DCD reOLTs were performed up to 1-1-2017. For the matched control group, 38 DBD reOLTs were selected. Comparison of recipient age, cold ischemia time, MELD score and BAR score showed no difference between the DBD and DCD group, only the DBD donors had a higher age than the DCD donors (54 [39-59] vs. 38 [20-45] years, p<0.001). No difference was observed between DBD and DCD reOLTs in post-transplant peak serum ALT values (1185 [628-2493] vs. 1238 [528-2522] u/L, p=0,729), prevalence of non-anastomotic biliary strictures (10,5% vs. 26,3%, p=0,143) and EAD (35,1% vs. 47,4%, p=0,375). One year graft survival after reOLT was similar for DBD and DCD livers (73,7% vs. 78,9%, p=0,754).

Conclusion

Retransplantation of the liver using a DCD liver graft does not result in inferior results compared to DBD livers. DCD liver grafts should not routinely be declined for patients requiring retransplantation.